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Biomedical subjects

K Lechner

Publications and source records attributed to K Lechner.

At least 397 records · Page 22Linked to original sources

Effect of treatment with activated prothrombin complex concentrate (FEIBA) on factor VIII-antibody level.

The influence of treatment with an activated prothrombin complex preparation (FEIBA) on the antibody level was studied in 10 haemophiliacs with an antibody to factor VIII. The antibody level was observed to rise at least once in five patients, while in the remaining five patients no rise occurred. In all, 6 out of 31 treatments were followed by an anamnestic rise of the antibody level, corresponding to 19.4%. A rise of the inhibitor level following FEIBA treatment is likely to occur in patients who show a marked antibody rise after factor VIII treatment (good responders), but have a low antibody level at the time of treatment. High doses of FEIBA and simultaneous of red cells may also enhance the likelihood of an anamnestic response. Stimulation of antibody production is probably due to the presence of small amounts of factor VIII in this preparation.

Antibodies↗

HLA antigens in immunologic thrombocytopenic purpura (ITP).

79 patients with definite ITP were investigated for HLA-A, -B, -C antigens. There was an increased frequencey of HLA-B5 in the entire groups (27.8% vs. 16.5% in controls and for HLA-B12 in male patients. However, after correction for the number of antigens tested, the difference of antigen frequencies became insignificant.

Adolescent↗

[Acute hemolysis in polycythemia vera].

The clinical course of fulminant haemolysis in a 54 year old patient with polycythaemia vera is described. Haemolysis was due to a complement-activating cold-autoantibody of the IgM class. A pathogenetic association between polycythaemia vera as a myeloproliferative disorder and autoimmune-haemolysis is discussed.

Acute Disease↗

[Splenectomy in idiopathic thrombocytopenic purpura: short- and long-term results (author's transl)].

The results of splenectomy in 25 patients with chronic idiopathic thrombocytopenic purpura (ITP) are reported. Splenectomy was performed when the platelet count was consistently less than 30,000/mm3 in spite of glucocorticoid therapy over an observation period of at least six months. Following splenectomy, 13 patients showed complete remission, 9 partial remission, whilst in 3 cases the condition was unaffected by splenectomy. It is not possible to predict a successful response to splenectomy on the basis of preoperative laboratory findings. A rise in thrombocyte count to over 400,000/mm3 during the first 2 weeks after splenectomy makes complete remission very likely.

Adolescent↗

[Antithrombin III deficiency and tendency to thrombosis (author's transl)].

Antithrombin III (AT III) was determined in 290 patients with deep venous thrombosis and/or pulmonary embolism by immunological methods (radial immunodiffusion, Laurell technique) and by biological activity (heparin cofactor activity and anti-Xa activity). Patients with venous thrombosis had a significantly lower AT III concentration, as determined by the immunological methods or biological method (heparin cofactor activity), than normal persons without any history of venous thrombosis. A decreased level of AT III was found in 27 patients. In these patients the immunoreactive antithrombin III was decreased to the same degree as biological activity (heparin cofactor activity or anti-Xa activity). Thirteen out of these 27 patients belonged to 9 families and, hence, congenital AT III deficiency can be assumed in these cases. The aetiology was unknown in the other half. Patients with AT III deficiency are prone to spontaneous and/or recurrent venous thrombosis. A high incidence of pulmonary embolism and particularly, of fatal pulmonary embolism is remarkable. In more than half of the patients the first thrombotic event occurred before the age of 35. The treatment of choice in such patients is with oral anticoagulants of the coumarin group.

Adult↗

Coagulation abnormalities in liver disease.

The decreased capacity of the liver to synthesize proteins is the main cause of decreased blood levels of clotting factors II, V, VII, IX, X and of antithrombin III in patients with liver disease. Therefore, determination of the activity or concentration of these coagulation proteins is a useful test of liver function and guide to prognosis, provided that other mechanisms which may influence the blood level are carefully considered. Clotting factor assays have an only limited value for the differential diagnosis in liver disease.

Acute Disease↗

[The disseminated intravascular coagulation. Diagnosis and therapy on a medical intensive care unit (author's transl)].

Disseminated intravascular coagulation (DIC) is a frequent acquired disorder of haemostasis in the patients at the medical intensive care unit. The pathogenesis, the different possible clinical manifestations and the obligatory laboratory tests are reviewed. In addition to the treatment of the underlying disease, the importance of adequate restoration of fluid volume and early administration of heparin is stressed.

Adolescent↗

[Synovectomy in the prevention of recurrent joint bleedings in haemophilia (author's transl)].

Synovectomy was performed in seven patients with severe haemophilia A, one with moderately severe haemophilia A and one with severe haemophilia B. Frequently recurring haemorrhages into one knee and demonstrated hypertrophic synovitis were the indications for operation in all. No serious bleeding complications occurred during or after the operations. After synovectomy the frequency of haemarthroses in the synovectomised joint decreased significantly. Satisfactory joint function was eventually achieved in all by gymnastic exercises and physiotherapy over a long period. The operation should only be done in large haemophilia centres were there is sufficient experience.

Adolescent↗

[Blood coagulation and fibrinolysis in women receiving estrogen, gestagen and estrogen-gestagen-contraceptives (author's transl)].

Eight femal subjects received a contraceptive with a low estrogen content (Neogynon), the estrogen component (50 mug ethinylestradiol) and consecutively the gestagen component (250 mug D-Norgestrel) of the contraceptive. Each treatment cycle was followed by a control cycle. At various times of the control and therapy cycles several coagulation and fibrinolytic parameters were investigated. Statistical analyses were performed by multivariate two-factorial analysis of variance. Plasminogen exhibities a statistically significant increase during the treatment with ethinylestradiol and the combination of this steroid with D-norgestrel. No significant changes were found for all other parameters, including partial thromboplastin time, fibriogen, factors X, IX, VIII, factor VIII-related antigen, antithrombin III and fibrin(ogen)degradation products.

Adult↗

[Intracranial and spinal hemorrhage in haemophilia (author's transl)].

Among 234 hemophiliacs, 14 patients (5.9%) with intracranial and 1 patient (0.4%) with intramedullary hemorrhage were observed and examined. The average age at the time of hemorrhage was 17 years in patients with severe hemophilia and 43 years in patients with moderate hemophilia. The patients with mild hemophilia and intracranial bleeding were 5 and 58 years old, respectively. Eight intracerebral, 3 subdural and 4 subarachnoid hemorrhages were encountered. In 7 cases bleeding was posttraumatic and in 5 it occurred spontaneously. In 2 patients hemorrhage followed a sudden increase of intracranial pressure. In 1 patient reliable data could not be obtained. Four of the 8 patients with intracerebral bleeding died; all survivors displayed some residual neurological abnormalities. All patients suffering from subarachnoid bleeding recovered completely. No serious complications were encountered after 3 lumbar punctures, 5 cerebral angiographies and after 1 myelography. Only in 1 case with an acquired inhibitor did a local hematoma develop at the site of puncture for the angiography. The same diagnostic procedures should be performed after substitution therapy with anti-hemophiliac plasma in a hemophiliac without inhibitor as in non-hemophiliacs if intracranial or intramedullar bleeding is suspected. In hemophiliacs with an anticoagulant, angiography or lumbar puncture should be performed only in exceptional cases.

Adolescent↗

Sonography: a method for localization of hematomas in hemophiliacs.

Sonography was used to visualize hematomas in hemophilic patients. The method is especially helpful for the diagnosis of psoas hematoma and retroperitoneal hematoma and allows the follow-up of hematomas of the cervical region and muscle hematomas. The method is simple, rapid, painless and has no known adverse effects.

Abdomen↗